Healthcare Provider Details

I. General information

NPI: 1265049266
Provider Name (Legal Business Name): MBO VISION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2020
Last Update Date: 10/05/2021
Certification Date: 10/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18148 W 92ND LN SUITE 400
ARVADA CO
80007-8164
US

IV. Provider business mailing address

18148 W 92ND LN SUITE 400
ARVADA CO
80007-8164
US

V. Phone/Fax

Practice location:
  • Phone: 720-722-5535
  • Fax:
Mailing address:
  • Phone: 720-722-5535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE GRAZIANI
Title or Position: PRESIDENT
Credential: OD
Phone: 720-722-5535